Diseases of the Colon & Rectum

, Volume 39, Issue 10, pp 1126–1129 | Cite as

Diagnosis and outcome of isolated rectal tuberculosis

  • A. S. Puri
  • J. C. Vij
  • A. Chaudhary
  • Nirmal Kumar
  • A. Sachdev
  • V. Malhotra
  • V. K. Malik
  • S. L. Broor
Original Contributions


PURPOSE: Segmental colonic tuberculosis commonly involves the ascending, transverse, or sigmoid colon. Rectal involvement in tuberculosis is uncommon and poorly characterized. This study describes the clinical presentation, endoscopic features, and outcome of isolated rectal tuberculosis. METHODS: Isolated rectal tuberculosis was defined as focal lesions of the rectum in the absence of radiologically demonstrable lesions in the small and large bowel on barium contrast studies. Diagnosis of rectal tuberculosis was based on characteristic endoscopic appearance of lesions, histopathologic features of tuberculosis in biopsy/ resected material, and response to antitubercular therapy. RESULTS: Eight patients with rectal tuberculosis were seen during a four-year period at our hospital. Hematochezia was the most common presenting feature (88 percent), followed by constitutional symptoms (75 percent) and constipation (37 percent). Rectal examination revealed a tight stricture within 10 cm of the anal verge in seven patients. Barium enema showed stricture of variable length, with focal areas of deep mucosal ulceration and increase in presacral space. Proctoscopic findings were tight stricture (7), nodularity with ulceration (6), and multiple aphthous ulcers (1). Granulomatous infiltration was detected in seven of eight patients in biopsy material obtained at endoscopy (6) or surgery (1). Cessation of hematochezia, resolution of constitutional symptoms, and weight gain were seen in all patients following treatment with antitubercular drugs. CONCLUSION: Our data suggest that tubercular involvement of rectum, although uncommon, is an important cause of rectal strictures in India. Response to antitubercular chemotherapy is uniformly good, and surgery is seldom required in these patients.

Key words

Segmental colonic tuberculosis Rectal stricture Mycobacterical infection 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Paustian FF, Marshall JB. Intestinal tuberculosis. In: Berk JE, ed. Bockus gastroenterology. Vol. 3. Philadelphia: WB Saunders, 1985:2018.Google Scholar
  2. 2.
    Pujari BD. Experience with tuberculosis of the large bowel. Indian J Surg 1989;51:57–64.Google Scholar
  3. 3.
    Shah S, Thomas V, Mathan M,et al. Colonoscopic study of 50 patients with colonic tuberculosis. Gut 1992;33: 347–51.Google Scholar
  4. 4.
    Yu-ao W, Wen-Yi Y. Isolated colonic tuberculosis. Postgrad Med J 1987;63:403–4.Google Scholar
  5. 5.
    Chawla S, Mukherjee P, Bery K. Segmental tuberculosis of the colon: a report of 10 cases. Clin Radiol 1971;22:104–7.Google Scholar
  6. 6.
    Bhargava DK, Kushwaha AK, Dasarathy S, Shriniwas, Chopra P. Endoscopic diagnosis of segmental colonic tuberculosis. Gastrointest Endosc 1992;38:571–4.Google Scholar
  7. 7.
    Gupta OP, Dube MK. Tuberculosis of the gastro-intestinal tract; with special reference to rectal tuberculosis. Indian J Med Res 1970;58:979–84.Google Scholar
  8. 8.
    Hawley PR, Wolfe HR, Fullerton JM. Hypertrophic tuberculosis of the rectum. Gut 1968;9:461–5.Google Scholar
  9. 9.
    Jones LM. Rectal tuberculosis. Contemp Sug 1985;26:41–3.Google Scholar
  10. 10.
    Chaudhary A, Gupta NM. Colorectal tuberculosis. Dis Colon Rectum 1986;29:736–41.Google Scholar
  11. 11.
    Arya TV, Jain AK, Kumar M, Agarwal AK, Gupta JP. Colonic tuberculosis: a clinical and colonoscopic profile. Indian J Gastroenterol 1994;13(Suppl):A1116.Google Scholar
  12. 12.
    Bhargava DK, Tandon HD, Chawla TC, Shriniwas, Tandon BN, Kapur BM. Diagnosis of ileocaecal and colonic tuberculosis by colonoscopy. Gastrointest Endosc 1985; 31:68–70.Google Scholar
  13. 13.
    Rai RR, Nijhawan S, Bhargava N, Nepalia S, Pokharna DS. Rectal tuberculosis: a case report. Indian J Tubercl 1993;40:35–7.Google Scholar
  14. 14.
    Chen W, Leu S, Hsu H, Lin J, Lin T. Trend of large bowel tuberculosis and the relation with pulmonary tuberculosis. Dis Colon Rectum 1992;35:189–92.Google Scholar
  15. 15.
    Jakubowski A, Elwood RK, Enarson DA. Clinical features of abdominal tuberculosis. J Infect Dis 1988;158: 687–92.Google Scholar
  16. 16.
    Fulton JO, Lazarus C. Varicose anorectal tuberculosis: a case report. S Afr Med J 1987;71:108–9.Google Scholar
  17. 17.
    Ahmed ME, Hassan MA. Abdominal tuberculosis. Ann R Coll Surg Engl 1994;76:75–9.Google Scholar
  18. 18.
    Shukla HS, Gupta SC, Singh G, Singh PA. Tubercular fistula-in-ano. Br J Surg 1988;75:38–9.Google Scholar
  19. 19.
    Balthazar EJ, Bryk D. Segmental tuberculosis of the distal colon: radiographic features in 7 cases. Gastrointest Radiol 1980;5:75–80.Google Scholar
  20. 20.
    Anand BS, Schneider FE, El-Zataari FA, Shawar RM, Claridge JE, Graham DY. Diagnosis of intestinal tuberculosis by polymerase chain reaction on endoscopic biopsy specimens. Am J Gastroenterol 1994;89:248–9.Google Scholar
  21. 21.
    Jain BK, Chandra SS, Narsimhan R, Ananthakrishnan N, Mehta RB. Co-existing tuberculosis and carcinoma of the colon. Aust N Z J Surg 1991;61:828–31.Google Scholar
  22. 22.
    Mann CV. The rectum. In: Rains AJ, Mann CV, eds. Bailey and Love's short practice of surgery. 20th ed. London: ELBS, 1989:1119.Google Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1996

Authors and Affiliations

  • A. S. Puri
    • 1
  • J. C. Vij
    • 1
  • A. Chaudhary
    • 2
  • Nirmal Kumar
    • 1
  • A. Sachdev
    • 2
  • V. Malhotra
    • 3
  • V. K. Malik
    • 4
  • S. L. Broor
    • 1
  1. 1.Department of GastroenterologyG. B. Pant and LNJP HospitalsNew DelhiIndia
  2. 2.Department of Gastrointestinal SurgeryG. B. Pant and LNJP HospitalsNew DelhiIndia
  3. 3.Department of PathologyG. B. Pant and LNJP HospitalsNew DelhiIndia
  4. 4.Department of SurgeryG. B. Pant and LNJP HospitalsNew DelhiIndia

Personalised recommendations